“Power dynamics are at play in every interaction when aligning sectors, in ways visible (e.g., who is and is not represented on an advisory committee) and invisible (e.g., which sector brings the most money to the table)…. These differences in power can result from imbalances in resources, perceived value, historical practices, influence, or experience.”³⁸

“How do we authentically engage community to help solve problems and address challenges? Communities might not define challenges in the same way or might even have a different way of thinking about the challenges than we would. We need to understand from a community’s perspective. It’s about the agency of individuals.”

– ACH Staff, CA

Key Takeaways

MSCs can help balance power dynamics among participants by building transparency into decision making, ensuring decision making entities are representative of the community served, and creating opportunities specifically for historically marginalized and underserved groups.
MSC participants had positive perceptions of power dynamics, suggesting that power imbalances can be addressed through multisector collaboration.
Power dynamics, like equity, should be considered in different ways, such as the dynamics among people, organizations, sectors, and boundaries (e.g., neighborhoods, cities, counties, Tribal Nations).

Power dynamics are inevitable among different sectors, organizations, communities, and individuals.^39,40 These power dynamics can influence MSC priorities and how work is done in a community.^41,42 As large, complex networks of organizations, MSCs must confront the power imbalances that arise when certain groups have more resources and influence than others.^43,44 Many research participants remarked that the health care sector has historically held maximal power and continues to exert strong influence in their health-focused MSC. However, we also saw MSCs shift power to community members, small organizations, rural communities, and tribal nations in a way that would not have happened without an MSC’s intentional focus to level the playing field and ensure all people, organizations, communities, and tribes had a fair opportunity to participate in MSC activities. Power shifts happened through shared decision-making, consultation, and funding approaches. Learn more about these power-shifting approaches in PHIL’s report, Advancing Equity: Adapting to Local Context and Confronting Power Dynamics. Lessons Learned from Accountable Communities of/for Health.

Survey Findings

81% of MSC staff and community residents said that their work / engagement with the MSC has increased their sense of power to change or influence their local community a moderate amount or a great deal (n=89).
94% of respondents agreed that other participants and staff take their opinion seriously in the course of discussions (n=427).

“I think there really needs to be shared decision making with the big institutions—hospital, county, the universities—and people who have been marginalized and oppressed. I think we need to do a better job of listening to their voice and giving power to people who have been powerless. So I think listening and including, and it starts with listening, I think we need to hear the stories and understand. And I think we probably have to slow down in order to do that. If you’re kind of pushing hard ahead always, you’ll miss it, or you’ll do it the wrong way.”

– Health Care Representative, CA

Perceptions of Power Dynamics

MSC participants had mixed feelings about their MSC’s ability to effectively address power dynamics. Perceptions of power dynamics varied by different local contexts and participant backgrounds. We found that:

MSCs that served smaller geographic areas tended to have better perceptions of power dynamics.
People with higher incomes tended to have better perceptions of power dynamics.

“I think the hospitals and health systems tend to have more power related to resources…but I actually believe that our community partners actually have more social influence power, especially in a region as diverse and as concentrated… like a small community-based organization that addresses health issues of the Somali population. That can actually be the primary influence to have access to the Somali population.”

– ACH Staff, WA

Related Resources

Advancing Equity with Multisector Collaboration, a Population Health Innovation Lab (PHIL) research brief (2023)
Advancing Equity: Adapting to Local Context and Confronting Power Dynamics. Lessons Learned from Accountable Communities of/for Health, a Population Health Innovation Lab (PHIL) report (2022)
Advancing Equity: Adapting to Local Context and Confronting Power Dynamics, a Population Health Innovation Lab (PHIL) web discussion (2022)
Keeping the Focus on Equity with ACHs, a Population Health Innovation Lab (PHIL) research presentation (2021)

View all references for the Data Walk.